[Question #3853] How protective are properly used condoms?

86 months ago

I am a heterosexual single male in the US in my early 30's. So yesterday I had condom protected anal sex with a woman in her 40s I met online. The condom was on the whole time and did not break. I asked her about her HIV and STD status and she said she is clean. She also says she takes PrEP every day because she is polyamorous and enjoys sex with multiple partners.

1) Did I put myself at risk for HIV in this situation?

2) Is there any realistic chance of acquiring HIV from condom protected vaginal or anal sex if the condom is worn the whole time and there is no condom breakage?

3) I know you guys recommend periodic HIV/STD testing for sexually active people who are not in committed relationships, even with the consistent condom use. Is my understanding correct that this recommendation is based on unrecognized condom breaks or people improperly using condoms? Or is it such that even with correct condom use without breakage, there is still inherent risk with respect to HIV and other fluid transmitted STDs?

Thank you.

Edward W. Hook M.D.

86 months ago

Welcome to the Forum and thanks for your question. I would estimate that your risk of acquiring HIV or other STIs from the encounter was virtually zero for two different reasons. Your partner's use of PrEP indicates that she perceives herself to be at risk for HIV and the to protect herself from HIV during otherwise unprotected sex. As long as she uses PrEP her risk for HIV is virtually zero. At the same time however, because PrEP is all about unprotected sex, she is at very high risk for other STIs and the occurrence of non-HIV STIs in persons taking PrEP is very, very high. You protected yourself from these other STIs however through your condom use.

The effectiveness of preventing STIs through correct and consistent condom use has been extensively study but because ultimately sexual activity cannot be directly observed to determine whether or not the condoms were really used correctly and did not break, investigators assume that some study participants state that condoms were used correctly when that might not be the case (because they do not want to admit their failure to use the condoms correctly to an outside "authority figure" [the investigator]). Despite this concern however, the best studies of condoms and their protective effect indicate that they are highly effective for preventing STIs like gonorrhea, chlamydia and trichamonas and while they offer a high degree of protection, that protection is not 100% for so-called "lesion diseases" (herpes, syphilis, HPV) in which the condom may not entirely cover the sites of sexual contact. Despite this however, they are highly protective. On this site when you factor in the facts that most people will not have STIs and that STIs are not transmitted 100% of the time that a person is exposed, we say that condoms reduce the risk of STIs to close to zero.

In answer to your specific questions:

1) Did I put myself at risk for HIV in this situation?

Probably not for the reasons mentioned above. You could be struck by lightening too but it is most unlikely.

2) Is there any realistic chance of acquiring HIV from condom protected vaginal or anal sex if the condom is worn the whole time and there is no condom breakage?

Probably not. See my lightening comment above, your risk of HIV is lower.

Our perspective is that it is better to be safe than sorry and that testing is easy to do. Thus we would still recommend periodic testing but mostly out of an abundance of caution more than anything else.

I hope these comments are helpful. The topic is complex. Please use your up to two follow-up questions for anything that is unclear. EWH

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86 months ago

Thank you Dr. Hook for your informative reply.

So given that this was a virtually no risk event, do you think I can forget about it and move on? Or would testing be indicated?

In a broader sense, is testing ever indicated for an event of vaginal or anal sex when condom protection was complete without breakage?

Thank you once again.

Edward W. Hook M.D.

86 months ago

I see no need for testing related to the event you described and, in the broader sense, do not see a need for event-specific testing if a condom was worn and did not break. As I said before however, that does not contradict our suggestion that periodically (annually or more, depending on partner number, etc.) all persons who have sex with multiple partners, or whose partners have sex with others should be tested. EWH
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86 months ago

Hi Dr. Hook,

I thought I would use my second allowed follow up to provide a little more information. I have decided at this point to not engage in penetrative sex and stick to no risk activities moving forward (i.e. Kissing, mutual masturbation) until getting into a monogomous committed relationship. For periodic testing purposes, I took an Oraquick test on Saturday. My previous negative test was last year also Oraquick. The year before that I had a negative rapid finger prick test, rapid gold I believe.

Since previously testing negative, I've had a couple instances of protected vaginal sex, but they were well beyond three months before taking this test. In addition to the event last week we discussed, there are two other events that fall short of the complete 3 month window period. This test was 5 weeks subsequent to having protected vaginal sex with a woman I met online in her 50s and caucasian, who said she had not had sex at all in 7 years since getting divorced. This test was also about 8-9 weeks subsequent to having protected vaginal sex with another woman I met online in her early 30s, caucasian, noting that I did not get to inquire about her testing status . Both of these other events for sure involved complete condom coverage with no breakage.

1) Given what you have told me and what I've read on this forum, I have calculated that my risk of HIV is nonexistent and I do not need further testing, assuming I stick to no risk activities moving forward. Is my thinking is correct?

2) Just to clarify about the shortcomings of Oraquick.. Is it such that rarely some people who have acquired HIV never test positive with Oraquick no matter how long after trasmission they test? Or is it such that rarely it takes up to three months to test positive Oraquick?

Thank you. I want to say that you, Dr. Handsfield and Ms. Warren provide an incredible service with this forum. As clinicians you are helping so many individuals by providing expert, dependable information when such is needed in a world of so much misinformation. I amongst many others truly appreciate it.

Edward W. Hook M.D.

86 months ago

1. I agree with your assessment and see no read for further testing related to the events you have described.

2. A bit of both occur. It is VERY rare but there are a tiny group of people who do not test positive with OraQuick, no matter when they are tested. In most of the persons with HIV not detected by the OraQuick test the issue is the timing of the test.

This is my 3rd response to your questions. Thus, as per Forum Guidelines, this thread will be closed later today. Congratulations on your approach to your sexual health and your practice of safe sex. It will keep you healthy. EWH

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